Lethal means counseling for suicide prevention: Views of emergency department clinicians

Siry-Bove, Bonnie; Polzer, Evan R.; Omeragic, Faris; Knoepke, Christopher E.; Matlock, Daniel D.; Betz, Marian E.

doi:10.1016/j.genhosppsych.2021.04.011

Cited by 11 publications

(15 citation statements)

References 24 publications

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“…Such low-cost resources offer opportunities to augment clinician-provided care, reduce required clinician time, and overcome system-level barriers, such as limited staffing and mental health clinician access. Stakeholder feedback, however, underscored the importance of delivery with a "human touch" (21), after some clinician contact/evaluation. Parents and clinicians further noted the value of offering the DA after families had a chance to process the suicidal episode and the focus was on discharge and safety planning.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, a broader focus allows greater reach to more patients, enhancing feasibility and potential suicide prevention value. Indeed, the adult L2L DA was expanded to address medication storage and translated to Spanish (20,21). However, this broader focus lengthens the DA with potential for reducing user acceptability.…”

Section: Discussionmentioning

confidence: 99%

“…Decision aids (DAs) can be developed as digital tools that can augment clinician interactions by offering patients education on potentially difficult decisions, considering their values and personal preferences (19)(20)(21). These clinical tools have been used to support complicated health-related decisions such as those involving medical treatments, end of life care, and disease screening.…”

Section: Introductionmentioning

confidence: 99%

“…Systematic reviews support the benefits of DAs for enhancing decision-making, decreasing decisional conflict, and improving patient-provider communication and shared decision making (22)(23)(24). More specifically, a recently developed webbased DA to support lethal means counseling in suicidal adults ("Lock to Live, " L2L) has demonstrated feasibility and acceptability with ED patients and providers (19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

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“Lock and Protect”: Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth

et al. 2021

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Objective: Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This article describes a parent/caregiver-facing web-based decision aid, the development process, and user testing.Method: A user-centered, participatory, mixed methods development design was employed. Beginning with an adult-focused decision aid developed by members of our team, we assessed ten iterations of the parent/caregiver decision aid with stakeholders (N = 85) using qualitative interviews and quantitative surveys. Stakeholders included: parents/caregivers whose children had histories of suicidal episodes before age 25, young adults with histories of suicidal thoughts/behaviors, firearm owners/representatives from firearm stores/ranges/groups, mental and medical health care providers, and emergency responders.Results: The final “Lock and Protect” decision aid was viewed as “useful for changing access to lethal means” by 100% of participants. Ninety-four percent of participants rated the information on reducing access to lethal means as good to excellent, and 91% rated the information on storage options as good to excellent. Qualitative feedback underscored a preference for offering this digital tool with a “human touch,” as part of safety and discharge planning.Conclusions: “Lock and Protect” is a user-friendly web-based tool with potential for improving rates of lethal means counseling for parents/caregivers of suicidal youth and ultimately reducing pre-mature deaths by suicide.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“Lock and Protect”: Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth

et al. 2021

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“…L2L addresses the lack of provider knowledge for different firearm and medication storage options ( 20 ). A survey showed that clinicians thought L2L would help them counsel suicidal adult patients on safe firearm storage options ( 21 ). A small pilot trial of 49 adult patients, evaluated in the emergency setting for a suicide-related concern, showed high satisfaction with L2L and non-significant increases in safe storage behavior ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

“Lock to Live” for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system

Boggs

Quintana

Beck

et al. 2022

Front. Digit. Health

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ObjectiveFew patients with suicide risk are counseled on lethal means safety by health providers. This study tested the feasibility of different delivery methods for Lock to Live (L2L), a web-based decision aid of safe storage options for firearms and medications.MethodsPatients reporting suicide ideation on the PHQ9 depression screener during outpatient health visits were included. Invitation messages to visit L2L were sent via combinations of email, text, Electronic Health Record (EHR) message, mailed letter, or provider referral, followed by a survey about storage behavior and acceptability. Provider interviews evaluated logistical considerations and acceptability.ResultsThe population-based method reached 2,729 patients and the best method (EHR message plus 2 email reminders) had 11% uptake (L2L visitation rate). Provider referral had small reach (14 patients) and 100% uptake (all visited). Provider interviews identified several strategies to promote uptake including: EHR reminders, provider training, quality metrics with accountability, a clearly communicated lethal means screening/counseling policy, and strong organizational leadership support.ConclusionDespite the low uptake for population-based (11%), far more patients with suicide risk were engaged in the L2L tool through population-based outreach than provider-referral over the same time frame.

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Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

et al. 2022

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ImportanceUS residents report broad access to firearms, which are the most common means of suicide death in the US. Standardized firearm access questions during routine health care encounters are uncommon despite potential benefits for suicide prevention.ObjectiveTo explore patient and clinician experiences with a standard question about firearm access on a self-administered mental health questionnaire routinely used prior to primary care and mental health specialty encounters.Design, Setting, and ParticipantsQualitative semistructured interviews were conducted from November 18, 2019, to October 8, 2020, at Kaiser Permanente Washington, a large integrated care delivery system and insurance provider. Electronic health record data identified adult patients with a documented mental health diagnosis who had received a standard question about firearm access (“Do you have access to guns? yes/no”) within the prior 2 weeks. A stratified sampling distribution selected 30% who answered “yes,” 30% who answered “no,” and 40% who left the question blank. Two groups of clinicians responsible for safety planning with patients at risk of suicide were also sampled: (1) licensed clinical social workers (LICSWs) in primary and urgent care settings and (2) consulting nurses (RNs).Main Outcomes and MeasuresParticipants completed semistructured telephone interviews, which were recorded and transcribed. Directive (deductive) and conventional (inductive) content analyses were used to apply knowledge from prior research and describe new information. Thematic analysis was used to organize key content, and triangulation was used to describe the intersections between patient and clinician perspectives.ResultsThirty-six patients were interviewed (of 76 sampled; mean [SD] age, 47.3 [17.9] years; 19 [53%] were male; 27 [75%] were White; 3 [8%] were Black; and 1 [3%] was Latinx or Hispanic. Sixteen participants had reported firearm access and 15 had reported thoughts of self-harm on the questionnaire used for sampling. Thirty clinicians were interviewed (of 51 sampled) (mean [SD] age, 44.3 [12.1] years; 24 [80%] were female; 18 [60%] were White; 5 [17%] were Asian or Pacific Islander; and 4 [13%] were Latinx or Hispanic) including 25 LICSWs and 5 RNs. Key organizing themes included perceived value of standardized questions about firearm access, challenges of asking and answering, and considerations for practice improvement. Clinician interview themes largely converged and/or complemented patient interviews.Conclusions and RelevanceIn this qualitative study using semistructured interviews with patients and clinicians, a standardized question about firearm access was found to encourage dialogue about firearm access. Respondents underscored the importance of nonjudgmental acknowledgment of patients’ reasons for firearm access as key to patient-centered practice improvement.

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Lethal means counseling for suicide prevention: Views of emergency department clinicians

Cited by 11 publications

References 24 publications

“Lock and Protect”: Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth

“Lock and Protect”: Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth

“Lock to Live” for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

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